Effect of different degrees of hypothermia on myocardium in treatment of hemorrhagic shock.
The use of hypothermia in cardiac and neurologic surgery is well established, but its use in treating hemorrhagic shock is controversial. Using a modified Wiggers hemorrhagic shock model, we examined the effects of hypothermia (group 1, 33 degrees C, N = 7; group 2, 28 degrees C, N = 12) after inducing hemorrhagic shock. In group 3, N = 6, dogs were maintained at body temperature in hemorrhagic shock and throughout resuscitation (normothermic shock). Sixty minutes after resuscitation (shed blood and lactated Ringer's solution, 50 ml/kg body wt), all hypothermic dogs were rewarmed and studied for an additional 120 min. Comparison of moderately hypothermic, severely hypothermic, and normothermic dogs showed a lower heart rate (80.6 +/- 3.3, 62.5 +/- 4.1, and 136.7 +/- 4.2 beats/min, P less than 0.05), reduced rate of left ventricular pressure fall (938 +/- 125, 700 +/- 75, and 1550 +/- 275 mm Hg/sec, P less than 0.05), a lower arterial pH (7.15 +/- 0.02, 7.10 +/- 0.03, and 7.24 +/- 0.02, P less than 0.05), a lower respiratory rate (18 +/- 1, 14 +/- 1, and 24 +/- 2 breaths/min, P less than 0.05), and a higher arterial pCO2 (36.6 +/- 1.6, 46.9 +/- 4.6, and 20.3 +/- 2.0 mm Hg, P less than 0.05). Left ventricular end-diastolic pressure was lower in the severely hypothermic dogs while stroke volume was higher in this group. Rewarming ablated all differences in cardiovascular performance and acid-base balance. Our data show that moderate hypothermia during hemorrhagic shock increased coronary perfusion, enhanced cardiac contractile performance, and significantly reduced myocardial oxygen requirements.(ABSTRACT TRUNCATED AT 250 WORDS)
Meyer
D M
DM
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031.
Horton
J W
JW
D000136:Acid-Base Equilibrium; D000818:Animals; D003326:Coronary Circulation; D004285:Dogs; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006439:Hemodynamics; D007036:Hypothermia, Induced; D008297:Male; D009206:Myocardium / Q000378:metabolism*; D010101:Oxygen Consumption; D012771:Shock, Hemorrhagic / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*